Diagnosing oesophageal cancer

If your GP suspects oesophageal cancer, they will examine you, arrange initial tests and refer you to a specialist, such as a gastroenterologist. These are some of the tests you may have:

Endoscopy and biopsy

The main tests are endoscopy and biopsy, which are often done at the same time.

An endoscopy (also called a gastroscopy or upper endoscopy) lets your doctor look inside your oesophagus and stomach. It is usually done as day surgery. Before the test, you will probably need to fast (not eat or drink) for about 6 hours.

You could be offered a light sedation to make the procedure more comfortable.

A general anaesthetic is only needed in a small number of cases. Once the sedative takes effect, a long, flexible tube with a light and small camera on the end (endoscope) is passed into your mouth, down your throat and oesophagus, and into your stomach and small bowel.

If the doctor sees anything unusual during the endoscopy, they may take a small sample of tissue (biopsy). A specialist, called a pathologist, will check the tissue sample under a microscope to look for cancer.

The endoscopy takes about 10 minutes. You may feel sleepy afterwards, so someone will need to take you home. You may also have a sore throat or feel bloated for a short time.

Endoscopic ultrasound (EUS)

An EUS is often done at the same time as a standard endoscopy. Sometimes it is done shortly after if more information is needed or to help with staging (see opposite). The doctor uses an endoscope with an ultrasound probe on the tip or with a built-in ultrasound device. The probe releases soundwaves that echo when they bounce off anything solid, such as an organ or tumour. 

If you have cancer, this test can help to show whether the cancer has spread into the oesophageal or stomach wall, nearby tissues or lymph nodes. During the EUS, your doctor may use the ultrasound to guide a needle into the area they want to look at and take tissue samples.

Staging

Working out how far the cancer has spread is called staging. It helps your doctors recommend the best 
treatment for you.

The TNM staging system is the method most often used to stage oesophageal cancers. TNM stands for “tumour, node, metastasis”. The specialist gives numbers to the size of the tumour (T1–4), whether or not lymph nodes are affected (N0–N3), and whether the cancer has spread or metastasised (M0 or M1). Lower numbers mean the cancer is less advanced.

The TNM scores are combined to work out the overall stage of the cancer, from stage 1 to stage 4. Ask your doctor to explain what the stage of the cancer means for you. You can 
also call Cancer Connect 13 11 20.

Stages of oesophageal cancer

Stage 1 early or limited cancer – tumour is found only in the oesophageal wall lining.

Stages 2–3 locally advanced cancer – tumour has spread deeper into the layers of the oesophageal wall and to nearby lymph nodes.

Stage 4 metastatic or advanced cancer – tumour has spread beyond the oesophageal wall to nearby lymph nodes or parts of the body, or to distant lymph nodes and parts of the body.

Further tests

If a biopsy shows you have oesophageal cancer, you may have more tests to see if the cancer has spread. Some tests may be repeated during or after treatment to check your health and how well treatment is working.

Blood test

What it is: A sample of your blood is checked.

Why it’s done: Checks your general health, blood cell count and how your liver and kidneys are working.

What to expect: Quick test, usually a needle in your arm. 

Imaging scans

What it is: Pictures of the inside of your body using CT, MRI or PET–CT scans.

What to expect: Checks if the cancer has spread to other parts of your body.

Why it’s done: You lie still on a table. For some scans, a liquid dye (contrast) is injected into a vein. 

Laparoscopy

What it is: Keyhole surgery using a thin tube with a camera.

Why it’s done: Sometimes used to check if cancer has spread to the stomach’s outer layer or the lining of the abdomen.

What to expect: Done under general anaesthetic. The tube is inserted through small cuts in your belly. Afterwards, you may feel bloated or have shoulder pain.

Genomic testing

What it is: Special tests on tissue removed during surgery.

Why it’s done: Finds gene changes (mutations) in cancer cells to help decide which treatments may work best.

What to expect: No extra procedure is needed. Uses tissue already taken during surgery or biopsy.